Differentiating PTSD from anxiety and depression: Lessons from the ICD-11 PTSD diagnostic criteria

Anna C. Barbano, Willem F. van der Mei, Terri A. deRoon-Cassini, Ettie Grauer, Sarah Ryan Lowe, Yutaka J. Matsuoka, Meaghan O'Donnell, Miranda Olff, Wei Qi, Andrew Ratanatharathorn, Ulrich Schnyder, Soraya Seedat, Ronald C. Kessler, Karestan C. Koenen, Arieh Y. Shalev, Richard Bryant, Douglas Delahanty, Carel Goslings, Jan Luitse, Hanspeter MoergeliJoanne Mouthaan, Daisuke Nishi, Marit Sijbrandij, Sharain Suliman, Mirjam van Zuiden

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Abstract

Objective: Posttraumatic stress disorder (PTSD) is frequently associated with depression and anxiety, but the nature of the relationship is unclear. By removing mood and anxiety diagnostic criteria, the 11th edition of the International Classification of Diseases (ICD-11) aims to delineate a distinct PTSD phenotype. We examined the effect of implementing ICD-11 criteria on rates of codiagnosed depression and anxiety in survivors with recent PTSD. Method: Participants were 1,061 survivors of traumatic injury admitted to acute care centers in Israel. ICD-10 and ICD-11 diagnostic rules were applied to the Clinician-Administered PTSD Scale for DSM-IV. Co-occurring disorders were identified using the Structured Clinical Interview for DSM-IV (SCID). Depression severity was measured by the Beck Depression Inventory-II (BDI-II). Assessments were performed 0–60 (“wave 1”) and 90–240 (“wave 2”) days after trauma exposure. Results: Participants identified by ICD-11 PTSD criteria were equally or more likely than those identified by the ICD-10 alone to meet depression or anxiety disorder diagnostic criteria (for wave 1: depressive disorders, OR [odds ratio] = 1.98, 95% CI [confidence interval] = [1.36, 2.87]; anxiety disorders, OR = 1.04, 95% CI = [0.67, 1.64]; for wave 2: depressive disorders, OR = 1.70, 95% CI = [1.00, 2.91]; anxiety disorders, OR = 1.04, 95% CI = [0.54, 2.01]). ICD-11 PTSD was associated with higher BDI scores (M = 23.15 vs. 17.93, P < 0.001 for wave 1; M = 23.93 vs. 17.94, P < 0.001 for wave 2). PTSD symptom severity accounted for the higher levels of depression in ICD-11 PTSD. Conclusions: Despite excluding depression and anxiety symptom criteria, the ICD-11 identified equal or higher proportion of depression and anxiety disorders, suggesting that those are inherently associated with PTSD.

Original languageEnglish
Pages (from-to)490-498
Number of pages9
JournalDepression and Anxiety
Volume36
Issue number6
Early online date25 Jan 2019
DOIs
Publication statusPublished - Jun 2019

Funding

informatiomUS Public Health Service research grant #MH101227 to Arieh Shalev, Ronald Kessler, and Karestan Koenen.We are grateful for the contributions of Paul O'Connor at the Nathan Kline Institute for his invaluable assistance in data management and quality assurance. This study was funded by the US Public Health Service research grant (MH101227) to Arieh Shalev, Ronald Kessler, and Karestan Koenen. Dr. Matsuoka reports personal fees from Morinaga Milk, Eli Lilly, and NTT Data. Over the past 3 years, Dr. Kessler received support for his epidemiological studies from Sanofi Aventis; was a consultant for Johnson & Johnson Wellness and Prevention, Sage Pharmaceuticals, Shire, Takeda; and served on an advisory board for the Johnson & Johnson Services Inc. Lake Nona Life Project. Kessler is a co-owner of DataStat, Inc., a market research firm that carries out healthcare research. We are grateful for the contributions of Paul O'Connor at the Nathan Kline Institute for his invaluable assistance in data management and quality assurance. This study was funded by the US Public Health Service research grant (MH101227) to Arieh Shalev, Ronald Kessler, and Karestan Koenen. US Public Health Service research grant #MH101227 to Arieh Shalev, Ronald Kessler, and Karestan Koenen.

FundersFunder number
Johnson & Johnson Services Inc.
Johnson & Johnson Wellness and Prevention
Sanofi Aventis
US Public Health Service101227
National Institute of Mental HealthR01MH101227
Eli Lilly and Company
Shire
Neelan Tiruchelvam Trust
informatiomUS Public Health Service

    Keywords

    • anxiety disorders
    • comorbidity
    • depressive disorders
    • nosology
    • posttraumatic stress disorder

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